Tag Archives: orphanage

“A Healing Place”: Part I

I am in El Salvador and am reporting on a recent workshop I gave at the children’s home, Love and Hope, with my colleague and team member, Susana Fragano. Before my departure for El Salvador, I asked Rachel, in one of our regular skypes, what she and the tias and tios (caregivers) would like to have as the focus of the workshop. She said that what they really needed help with was how to manage severe behavior problems. She told me about some of the tantrums, insolence and noncompliance, and sexual behavior, of the children in the home. This behavior has gotten worse in the last year or so since LEPINA, the Salvadoran law that requires institutionalized children to be reunited with their biological families, has been implemented, causing most of the children in the home to be returned to their families in the community. These reunited children, when they return to the home at the request of their families – either for weekend visits or for longer stays – because the families declare themselves unable to care for them – demonstrate more problematic behavior than before the reunification. Whether the worsening in behavior is due to neglect and abuse the children report they have experienced during the time they were living with their families, whether it is a consequence of the disruption of a secure caregiving environment and the traumatic loss of the caring relationships they had enjoyed at the home, or whether it is simply due to their growing older, is not known.

In the next several blog postings I am going to report on my experiences at the home during this visit and the workshop we gave to the caregivers. For a reason that will become clear as I continue, I will call these postings, “A Healing Place”. I have awakened early to write, and as I open the curtains in the window of my favorite hotel in San Salvador, I look out on dark mountains in the near distance, palm trees and other tropical vegetation in the nearer distance, and the “Mister Donut” sign that protrudes above the rooftops and guides us home after a day’s work.

Pathway to Trouble

I introduced the workshop with a review of the sources of the problems that these troubled children now have. I reminded them of the important factors I have spoken to them about many times before: (1) Prenatal stress; (2) Early abuse and neglect; (3) A genetic contribution; (4) and the ongoing trouble caused by the effect of chronic stress on the developing brain. The more you repeat a problem behavior, the better your brain learns to repeat it. I would like to state at the beginning of this series of posts that many of the points I am making about traumatized children are equally valid in relation to children with serious developmental disturbances, such children on the autistic spectrum. That is because for these children ordinary life experiences with other people, even caring attention, can feel traumatizing.

Interrupting that Pathway to Trouble

This is what the stated goal of the children’s homes has always been. Put another way, it is “breaking the cycle” of the consequences of severe neglect and abuse. But this is very hard to do. It is also hard for caregivers to remember, to keep in mind, that the children they take care of have a story about pain and neglect in their brains. They carry it always, and it can emerge unpredictably in response to current experience. This story will not go away with good care. But it can become increasingly less potent, as a new story is created to take its place. The new story is about acceptance, trust, love, and hope. The new story is about healing.

A Healing Place

I then told them about an 8-year old girl I had observed the day before. Let’s call her “Angela”, not her real name. She entered the home at 3-years old as the victim of severe neglect and abuse, including sexual abuse. After 4 years in the home, she was “reunited” with her family. (It is important to remember that this ill-conceived law, LEPINA, was implemented abruptly, without adequate assessment of the families’ competence as caregivers, and without support for these families in the community.) When in Angela’s case the neglect and abuse began again, her family returned her to Love and Hope, with occasional weekend visits to her family. The day before yesterday, after a recent visit Angela made to her family, we observed her playing. She explained that she was making a “botiquin”. Neither Susana nor I understood the reference, so Susana asked her what a botiquin was. She explained that a botiquin was something that contained whatever you needed to make yourself better when you were hurt. With Rachel’s help, she carefully organized the contents she planned to put into the box when it was completed – band aids, tape, pretend thermometer, etc. Another girl in the home offered to help her with the project and was taping clean white paper onto the cardboard box with all the care of wrapping a present. As I watched this hurt child happily engaged in pretend play with the support of her primary caregiver and her friend, I thought to myself that she was representing in play the safety and comfort of Love and Hope. She was creating for herself a healing place.

Read this blog in Spanish.

Respecting Specificity

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Lou and Betty Sander, January, 2012

Photo courtesy of Marilyn Davillier

On Thursday, I attended a lecture by Charles Nelson, Ph.D., who is a professor of Pediatrics at Harvard Medical School and affiliated with the work of the Center on the Developing Child. He is a researcher who has done pivotal studies on brain development in relation to institutionalization in early childhood (Bos K, Zeanah C, Fox N, Drury S, McLaughlin K, & Nelson C, Psychiatric outcomes in young children with a history of institutionalization, Harvard Review of Psychiatry, January/February, 2011, pp. 15-24; Fox S, Levitt P, & Nelson C, How the timing and quality of early experiences influences the development of brain architecture, Child Development, January/February, 2010, Vol. 81, Number 1, pp. 28-40). I was impressed not only by the quality of the research, but also by Chuck Nelson’s commitment to using his research to achieve such important humanitarian goals. It is clear that he really cares about protecting the potential of young children living in circumstances devastating to their healthy development.

Last night I had dinner with close friends, and I was telling them about my dilemma. I very much believe in the value of the movement to reunite children with their families and support these families in the community where they live, but if only it were that simple. I also believe in what the good people from Better Care Network called “general systems approach” and “sustainability”. But I also see the damage that is being done in the short run as institutions such as the children’s homes that have emerged as the unique solution to a particular country’s abandoned children are dissolved by courts that do not take the needs of the individual children into account. In the children’s home, I have observed the opposite of what Chuck Nelson described in the Rumanian orphanages – that the earlier the children were when they entered the institution the more damaged they became in that developmentally damaging environment. By contrast, in the home, often the children who did the best were the ones who entered the home as infants, where they were well fed and protected, welcomed into a “home” of loving caregivers and older children who are also caregivers by nature through their belonging to a caregiving culture. I always call up my friend, Lou Sander’s thinking about specificity when I puzzle about this kind of dilemma (Sander, L. Living systems, evolving consciousness, and the emerging person: a selection of papers from the life and work of Louis Sander, The Analytic Press, New York, N.Y., 2008.)

My friends were arguing that there was nothing I could do, that “the pendulum swings” are large, and one will have to wait for the changes in reunification to be modified over time. They said, “Surely you agree that the bad orphanages are worse than any alternative!” I said I did agree bad orphanages were terrible, but that what was getting lost in the reunification initiative was the uniqueness of the societies and cultures of the children themselves and the specificity of the institutions that had arisen in those societies – the whole idea of “one size fits all”, which is an essentially reductive perspective.

It was an enjoyable discussion in which everyone listened respectfully to everyone else, and my friends insisted, “we all agreed” on the basics. They told me that I wasn’t a politician, and it would be immensely hard to try to make any change on that level. I had been thinking of all the other things I am involved in – all related to children and families, but in different venues – and I began to feel tired. Then I thought of the children in El Salvador that I knew. I thought of the heroic efforts of the children’s home to support the families in the community, and I felt inspired. I though of the previously academically successful, robust, beloved in the home, little boy who has recently been seen begging in the streets at midnight after reunification. I thought of the difference between the two approaches – the larger “systems” approach, and the “one starfish at a time” story – (In the story, a visitor encounters an old man sitting by the side of the sea taking starfish, one at a time, and throwing them back into the surf. The beach was full of stranded starfish. The visitor asked him, “Why are you taking the trouble to throw them into the sea? There are so many, and the surf will carry them all back anyway.” The old man kept picking up starfish and throwing them back into the surf one at a time. “You are correct,” he told the visitor, “But if I save one starfish, I will have done a good thing.”) and I was unsure. Wasn’t each starfish thrown back into the surf a “momento magico”? My friends have never been to El Salvador.

This post’s “Momento Magico”:

In the last post, I promised that in each posting I would include a “magic moment” told to me by a parent, teacher, or child. Here is the “magic moment” for this post.

In this loving family, a painful conflict between the parents has resulted in a sadness and hypervigilence in the two girls. In a recent family meeting, the older girl watches her parents’ faces closely, scanning for trouble, while the younger one seemingly picks up the emotional “vibes” indirectly and makes attention-getting gestures with the puppets from her position lying on the floor in the middle of the circle. I am thinking that I want to balance the openness to the expression of painful, angry feelings in the family, against the expression of hope. I don’t want to lose one or the other. As the characteristic painful pattern emerges – that of one parent feeling abandoned and devalued by the other and the second parent feeling “taken over” and marginalized by the first – I acknowledge this pattern as it occurred the night before the meeting. Then I ask for a “magic moment” in the past week. One parent identified the moment, the other agreed, and both girls enthusiastically elaborated the situation in which the younger child asked the older child for help with a puzzle, and the older one, instead of rejecting her, joined her in figuring out the problem. The entire family was enhanced by this small collaborative activity of the children. I attempted to make clear that the girls were not expected to take the parental responsibility in the family, but that this was one example of how all of them had the power to change bad habits. Every family member could partake in the positive feelings about themselves and about the family the two girls had generated. It is important to learn to recognize magic moments, because the more you recognize them, the more you will see the potential for them in an ordinary family interaction, and the more you can make them – and hope – happen.

Read this blog in Spanish.

Parallels in Resiliency

Workshops for Caregivers

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In order to learn about caregiving of children in care in developing countries, our team has been visiting the orphanage of Love and Hope. As is typical in orphanages in CA, most of the children are not actually orphans but have families that are unable to care for them because of financial, mental health, or other reasons. The children all have histories of severe neglect and maltreatment.

Orphanage Caregivers attending Workshop

In April, 2011, the team gave a second workshop to the caregivers in the orphanage. Following a consultation model, the workshop focused the caregivers’ chief concern – discipline – but underscored by the message of the importance of the relationship. Videotapes of caregivers setting limits in the orphanage were used to demonstrate successful limit setting techniques. The caregiver’s ability to imagine the mind of the child was crucial to the success of the interactions. Examples of the caregivers’ evaluations of the workshop included, “ I learned that it’s important to get at a child’s level, spend time with them, and connect with them first.” And “How to have a better relationship with a child and how to understand his situation.”

Read this blog in Spanish.